ATrain Education

 

Continuing Education for Health Professionals

Depression: Gender Matters

Module 4

Irritable Male Syndrome

When women are depressed, they . . . eat or go shopping. Men invade another country.

Comedian Elayne Boosler

Men get irritable. Women get sad.

Ron Kessler, PhD

Ron Kessler, a professor of healthcare policy at Harvard, describes depression in men this way: “When you study depression among children, they don’t talk about being sad, they talk about being angry and irritable. Children don’t have the cognitive capacity to make sense of all their feelings. There’s a great similarity between children and men. Men get irritable; women get sad” (Kessler, 2003).

The Irritable Male Syndrome: Understanding and Managing the Four Key Causes of Depression and Aggression (Diamond, 2004) reports on many men and women who were trying to better understand what was going on in their lives. Here are a typical woman and man.

A Woman’s View

For about a year nowit could be even longer, it’s hard to know exactlyI have felt my husband of 22 years pulling away from us. He has gradually become sullen, angry, and moody. His life energy is down and his sex drive has really dropped off.

Recently he has begun venting to anyone who will listen about how horrible we all are. He is particularly hard on our 19-year-old son Mark. It’s so surprising because our son has always been industrious and competent. My husband has always shared my view that Mark is one of the hardest-working kids we know. But all of a sudden that has changed. Mark still works from 6:30 until 4:30 every day, but now his Dad accuses him of being unmotivated, lazy, and any other negative thing he can think to say.

If the kids aren’t living up to his standards it is my fault; when they’re good it is because he has been such a positive influence in their lives. If there’s a problem, it must be because of the way I’ve raised them. I know that sounds bizarre, but that’s how he is thinking.

He blames me for everything these days. If his socks or underwear are missing, I must have put them somewhere to piss him off. I’m not kidding, that’s what he tells me. The thing that bothers me most is how unaffectionate he has become. I don’t even get the hugs I did in the past and, when he does touch me I feel grabbed rather than caressed. My husband used to be the most positive, upbeat, funny person I know. Now it’s like living with an angry brick!

 

A Man’s View

[Rick is a 52-year-old married man, with children aged 22 and 26. His responses are typical of many men who have spoken out.]

I think my irritability is related to my time of life and to the stresses that seem to be mounting both at work and at home. I’m an electrical engineer and work for a large company in the Midwest. There has been a great deal of “consolidation” over the last few years and many people have been let go or forced into early retirement. Even though I have been here a long time, and I don’t think I am vulnerable to losing my job, I still worry.

There is always so much to do and there never seems to be enough time. I have trouble staying on top of it all. I don’t have much physical or mental energy these days. All of this is affecting my sleep. My wife keeps asking me what’s wrong. I don’t know what to tell her. I usually answer that nothing is wrong. When she persists I often snap at her.

Although I love my wife, I feel we have grown apart over the years. We used to be very close, but now we often seem like opposites and that creates its own kind of stress. I can feel unappreciated, unheard, uncared about. She expresses the same feelings. Even though we are aware of it we don’t seem to be able to do anything about it. It’s very discouraging and depressing.

For me, depression and irritability are closely linked. I don’t really lash out that often. I mostly hold the feelings in. I don’t want to fight, but sometimes things erupt and I blow up at her. I can tell she’s hurt. I feel guilty and that makes me angrier. It seems to be a vicious cycle. She says I am often sarcastic and cutting. I don’t think I am, but maybe she’s right.

Another thing she complains about is how I drive. You might say that I have a good deal of road rage. When people cut me off or drive in a manner dangerous to others around them, I get furious. I’ll yell, pound the steering wheel, and once I even chased someone off the freeway to teach him a lesson. I was clearly out of control. My wife and I generally carpool to work and she hears all my cussing and sees all my gesturing. I know it makes her uncomfortable and she says it makes me look uneducated and low-class.

When we’re out having fun, I can go from being happy-go-lucky to being crabby in the blink of an eye. Something small will happen. I take it personally and become irrationally angry. For instance, I’ll be at a bar with some friends and if the waitress is slow in getting to the table, it infuriates me. Sometimes I’ll say something hurtful, like “It’s about time you got around to doing your job.” Other times I’ll just leave and go home, fuming all the way.

I lack a sense of well-being much of the time. I have come to doubt my ability to be a reliable, dependable, likeable person. My confidence in myself is low. When I feel hateful or annoyed with everyone I just want to isolate myself. That way I don’t have to deal with them and I won’t do things I’ll regret later. As a result, I have become estranged from my wife and children. Even at work, which used to be a place I felt comfortable and where I had a lot of friends, I feel cut off and isolated.

This depression/irritability syndrome affects everything in my life. I feel that I have achieved very little of what, as a young man, I had hoped to achieve. I long to be much more confident and competent, much more relaxed, much more self-sufficient, and much more successful. I hope you can help me.

What Is Irritable Male Syndrome?

Irritable male syndrome (IMS) is a state of hypersensitivity, anxiety, frustration, and anger that occurs in males and is associated with biochemical changes, hormonal fluctuations, stress, and loss of male identity. Working with males who are experiencing IMS, and with those who live with them, reveals that there are four core symptoms: hypersensitivity, anxiety, frustration, and anger.

Hypersensitivity: The First Core Symptom

The women who live with these men say things like:

  • “I feel as if I have to walk on eggshells when I’m around him.”
  • “I never know when I’m going to say something that will set him off.”
  • “He’s like a time bomb ready to explode but I never know when.”
  • “Nothing I do pleases him.”
  • “When I try to do nice things, he pushes me away.”
  • “He’ll change in an eye-blink. One minute he’s warm and friendly. The next he’s cold and mean.”

Often the men don’t recognize their own hypersensitivity. Their perception is that they are fine but everyone else is going out of their way to irritate them.

The men say things like:

  • “Quit bothering me.”
  • “You know I don’t like that. Why do you keep doing it?”
  • “Leave me alone.”
  • “No, nothing’s wrong. I’m fine. Quit asking questions.”
  • “Why don’t you ever . . . want sex, do what I want to do, do something with your life, think before you open your mouth, do things the right way?”
  • Or, they don’t say anything. They increasingly withdraw into a numbing silence.

One concept I have found helpful is the notion that many of us are “emotionally sunburned,” but others don’t know it. Think of a man who is deeply sunburned and gets a loving hug from his wife. He cries out in anger and pain. He assumes she knows he’s sunburned, so if she “grabs” him she must be trying to hurt him. She has no idea he is sunburned and can’t understand why he reacts angrily to her loving touch. This can lead a couple down a road of escalating confusion.

Anxiety: The Second Core Symptom

Anxiety is a state of apprehension, uncertainty, and fear resulting from the anticipation of a realistic or fantasized threatening event or situation. There are many real threats that men are dealing with in their livessexual changes, job insecurities, relationship problems. There are also many uncertainties that lead men to fantasize about future problems.

These kind of worries usually take the form of what-ifs. What if I lose my job? What if I can’t find a job? What if she leaves me? What if I can’t find someone to love me? What if I have to go to war? What if something happens to my wife or children? What if my parents die? What if I get sick and can’t take care of things? The list goes on and on.

Frustration: The Third Core Symptom

Princeton University’s WordNet offers two definitions that can help us understand this aspect of IMS.

  1. Frustration is the feeling that accompanies an experience of being thwarted in attaining your goals. Synonym is defeat.
  2. Frustration is a feeling of annoyance at being hindered or criticized. The dictionary offers an enlightening example to illustrate the use of the word: “Her constant complaints were the main source of his frustration.”

Men who have IMS feel blocked in attaining what they want and need in life. They don’t even know what they need. When they do know, they believe there’s no way they can get it. They feel defeated in trying to improve their lives. These men feel frustrated in their relationships with family, friends, and co-workers. The world is changing and they don’t know where, how, or even if they fit in.

Author Susan Faludi captures this frustration in her book Stiffed: The Betrayal of the American Man (1999).The frustration is expressed in the question that is at the center of her study of American males. “If, as men are so often told, they are the dominant sex, why do so many of them feel dominated, done in by the world?” This frustration, often hidden and unrecognized, is a key element of IMS.

Anger: The Fourth Core Symptom

Anger can be simply defined as a strong feeling of displeasure or hostility. Yet anger is a complex emotion. Outwardly expressed, it can lead to aggression and violence. Turned inward, it can lead to depression and suicide. Anger can be direct and obvious or subtle and covert. Anger can be loud or quiet. It can be expressed as hateful words, hurtful actions, or stony silence.

For many men, anger is the only emotion they have learned to express. Growing up male, we are taught to avoid anything that is seen as the least bit “feminine.” We are taught that men “do” while women “feel.” As a result men keep all emotions under wrap. We cannot show we are hurt, afraid, worried, or panicked. The only feeling allowed many men is anger. When men begin exhibiting IMS, anger is often its primary manifestation.

Whereas feelings like anger, anxiety, and frustration can occur quickly and end quickly, irritability can develop into a mood state that lasts a long time and may trigger the feelings over and over again. Anger can have a major impact on a person’s entire life. “When we’re in a mood, it biases and restricts how we think,” says Paul Ekman, professor of psychology and director of the Human Interaction Laboratory at the University of California Medical School in San Francisco (UCSF). Ekman is one of the world’s experts on emotional expression. In describing these kinds of negative moods, Ekman continues:

It makes us vulnerable in ways that we are normally not. So the negative moods create a lot of problems for us, because they change how we think. If I wake up in an irritable mood, I’m looking for a chance to be angry. Things that ordinarily would not frustrate me, do. The danger of a mood is not only that it biases thinking but that it increases emotions. When I’m in an irritable mood, my anger comes stronger and faster, lasts longer, and is harder to control than usual. It’s a terrible state . . . one I would be glad never to have. (Ekman, 2003)

What Causes Irritable Male Syndrome?

Case

Over the past three years, especially, my relationship with my wife has begun to deteriorate. In the past there were open displays of affection and frequent verbal affirmations. Now, I seem to be irritable all the time. My attitude seems to be “Don’t come near me, don’t talk to me, I had a hard day, I want the entire world to piss off.”

She now rarely tries to hug me, never initiates sex, and talks to me about half as much as she used to. It’s gotten to the point where I find out what’s going on in her life from my mother or sisters. We’re both miserable and its ruining our lives. I don’t understand what is causing me to act this way.

Although triggers vary for individual men, there are four key elements at the core of most men’s problems:

  1. Hormonal fluctuations
  2. Biochemical changes in brain chemistry
  3. Increasing stress
  4. Loss of male identity and purpose

Testosterone and IMS

In order to understand the way in which hormonal fluctuations cause IMS in men, we need to know something about testosterone. Theresa Crenshaw, author of The Alchemy of Love and Lust (1996), describes testosterone this way:

Testosterone is the young Marlon Brandosexual, sensual, alluring, dark, with a dangerous undertone. . . . [Testosterone] is also our “warmone,” triggering aggression, competitiveness, and even violence. “Testy” is a fitting term.

We know that men with testosterone levels that are too high can become angry and aggressive. Recent research shows, however, that most hormonal problems in men are caused by testosterone levels that are too low.

Gerald Lincoln (2001), who coined the term “Irritable male syndrome,” found that lowering levels of testosterone in his research animals caused them to become more irritablebiting their cages as well as the researchers who were testing them.

Serotonin and IMS

Most people have heard of the brain neurotransmitter serotonin. When we have enough flowing through our brains, we feel good. When there isn’t enough, we feel bad. Siegfried Meryn, author of Men’s Health and the Hormone Revolution (2000), calls serotonin “the male hormone of bliss.” Women have the same hormone in their brains and it has an equally positive effect on them. “The more serotonin the body produces,” says Meryn, “the happier, more positive and more euphoric we are. Low serotonin can contribute to a man’s irritability and aggression.”

One of the most common causes of low serotonin levels is diet. Many men believe that eating lots of red meat is “manly.” Judith Wurtman and colleagues (2006) at the Massachusetts Institute of Technology found that a high protein, low carbohydrate diet can cause increased irritability in men. They found that men often mistake their cravings for healthy carbohydratesfound in vegetables like potatoes, rice, corn, and squashwith cravings for the protein found in meat.

“Eating protein when we need carbohydrates,” says Wurtman, “will make us grumpy, irritable, or restless.” Wurtman’s team also found that alcohol consumption increases serotonin levels initially. However, chronic use dramatically lowers serotonin, resulting in depression, carbohydrate cravings, sleep disturbances, and being prone to argumentativeness and irritability.

Stress and IMS

We all know the feeling. We’ve had another one of those days at work. One deadline after another and there isn’t enough time to breathe. Someone always seems to be making more demands and no matter how hard we try to stay on top of things, we seem to be getting farther and farther behind. Many of us have lost our jobs. If we have a job we’re often working more hours for less money. The economy is in turmoil. Our savings are dwindling and our hopes for retirement seem to be fading away. We all know the feeling of being stressed out. But what exactly is stress and why is stress reduction so important?

In my experience as a psychotherapist, I have found that stress underlies most of the psychological, social, and medical problems (including IMS) that people face in contemporary society. For most of us, stress is synonymous with worry. If it is something that makes us worry, then it is stressful. However, our bodies have a much broader definition of stress.

To the body, stress is synonymous with change. It doesn’t matter if it is a “good” change, or a “bad” change, they are both stressful. A divorce is stressful; however, when you find your dream home and get ready to move, that too is stressful. Good or bad, if it is a change in your life it is interpreted as stress by your body.

We can’t avoid stress, nor would we want to. Life is change. The problem is what happens when there is too much change in too short a time. We might think of the problem that leads to irritable male syndrome as “dis-stress” or “overstress.” Stress is unavoidable, necessary, invigorating, and life-enhancing. Distress and overstress can cause untold problems if not understood and prevented.

So, what can we do to relieve stress? If you think about the kinds of stresses our bodies are designed to meet, they all involve physical activity. When a wild animal came into the camp of our hunter-gatherer ancestors, they either fought or ran away. Either way utilized a lot of physical energy. It’s physical activity that allows the body to attend to the stress and return to normal.

In our modern world, we usually don’t have wild animals bursting into our living rooms. The stresses are more psychological than physical. Yet the reaction is the same. Our bodies release stress hormones that can only be dissipated through physical activity. So, if you build up stress every day, you must do something physical every day. Walk, run, take an aerobics class. You’ll feel better and it’s a surefire way to treat IMS.

Loss of Male Identity and Purpose

For most of human history, the male role was clear. Our main job was to “bring home the bacon.” We hunted for our food and shared what we killed with family and tribe. Everyone had a role to play. Some were good at tracking animals. Others were good at making bows and arrows or spears. Some men could shoot an arrow with enough strength to kill a buffalo. Others were skilled at singing songs and doing dances that invoked the spirit of the animal and made the hunt more effective.

But now many of us work at jobs that we hate, producing goods or services that have no real value to the community. We’ve gotten farther and farther away from the basics of bringing home food we’ve hunted or grown our own. The money we receive is small compensation for doing work that is meaningless. Yet the men with some kind of job, no matter how bad it is, are the lucky ones. More and more men are losing their jobs and are unable to find new ones.

In Stiffed (1999), Susan Faludi concludes that male stress, shame, depression, and violence are not just a problem of individual men but a product of the social betrayal men feel as a result of a changing economic situation. One of the men Faludi interviewed at length could be speaking for millions of men:

There is no way you can feel like a man. You can’t. It’s a fact that I’m not capable of supporting my family. . . . When you’ve been very successful in buying a house, a car, and could pay for your daughter to go to college, though she didn’t want to, you have a sense of success and people see it. I haven’t been able to support my daughter. I haven’t been able to support my wife. I’ll be very frank with you: I. Feel. I’ve. Been. Castrated.

As Faludi interviewed men across the country, she confirmed something most adults know all too well. Men put a lot of their identity and sense of self-worth into their jobs. If we aren’t working or can’t support our family, we feel that we’re not really men. We need to help men realize there is more to who they are than a paycheck.

Male Depression and the Shifting Economy

Men in the changing economy will face the same risks for depression that women faced in older economies: trapped in a family role from which they cannot escape because of an inability to find employment.

Boadie W. Dunlop, MD

The factors impacting American men when Susan Faludi wrote Stiffed in 1999 are devastating men throughout the world in the current economic climate. An editorial in the British Journal of Psychiatry indicates that depression rates in men are on the rise and likely to increase further due to socioeconomic changes around the world. The study’s principle author Boadie Dunlop, of Emory University School of Medicine in Atlanta, writes:

Compared to women, many men attach a great importance to their roles as providers and protectors of their families. Failure to fulfill the role of breadwinner is associated with greater depression and marital conflict. (2011)

Research shows that since the beginning of the recession in 2007 roughly 75% of the jobs lost in the United States were held by men. Women are increasingly the primary household earners, with 22% of wives earning more than their husbands in 2007 as compared to only 4% in 1970. There is little reason to believe that traditional male jobs will return in significant numbers even when the economy fully recovers. Dunlop continues:

The recent recession afflicting Western economies serves as a harbinger of the economic future for men, especially for those with lower levels of education. Dubbed by some the “mancession,” the economic downturn has hit men particularly hard because of its disproportionate effect on traditional male industries, such as construction and manufacturing, although, of course, working women have also been affected. (2011)

In my clinical practice, I have seen an increasing number of men who are out of work or are afraid of losing their jobs. The experience is often devastating. They become anxious, irritable, angry, and sometimes suicidal. It not only impacts the men but also their families. Underlying these behaviors are experiences of loss and persistent feelings of hopelessness, helplessness, and worthlessness, the hallmarks of depression. Yet social pressures continue to discourage men from reaching out for help despite the increasing stresses they are experiencing.

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